Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer.
Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer.
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DOI：
10.1200/jco.2015.62.5764
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发表时间：
2015-10-20
期刊：
影响因子：
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通讯作者：
Carter HB
中科院分区：
文献类型：
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作者：
Tosoian JJ;Mamawala M;Epstein JI;Landis P;Wolf S;Trock BJ;Carter HB
在一项前瞻性的、积极的监测计划中，评估有良好风险的前列腺癌患者的长期结果。在前列腺活检中，对于疾病重新分类到更高的癌症级别或体积，建议进行根治性干预。主要结果是总的、癌症特异性的和无转移的生存。次要结果是重新分类和治疗干预的累积发生率。在COX比例风险模型中评估了与分级重新分类和治疗干预相关的因素。自1995年以来，共有1,298名男性(中位数年龄，66岁)进行了6,766人年的随访，平均随访时间为5年(从0.01到18.00年不等)。总体而言，10年的癌症特异性生存率和无转移生存率分别为93%、99.9%和99.4%，15年的生存率分别为69%、99.9%和99.4%。分级再分类的累积发生率10年为26%，15年为31%；治疗性干预的累积发生率为50%，15年为57%。中位无治疗生存期为8.5年(0.01~18年)。与分级重新分类相关的因素有年龄(危险比[HR]，每增加一年1.03；95%CI，1.01至1.06)，前列腺特异性抗原密度(HR，每0.1单位增加1.21；95%CI，1.12至1.46)，以及较多的阳性活检芯数(HR，每增加一个阳性核心1.47；95%CI，1.26至1.69)。与干预相关的因素是前列腺特异性抗原密度(HR，每0.1个单位增加1.38；95%CI，1.22~1.56)和较多的阳性活检芯数(HR，1.35，多一个阳性核心；95%CI，1.19~1.53)。患有前列腺癌风险较高的男性应该被告知，他们的诊断带来伤害的可能性很低，应该鼓励他们考虑进行监测，而不是进行治疗干预。
To assess long-term outcomes of men with favorable-risk prostate cancer in a prospective, active-surveillance program. Curative intervention was recommended for disease reclassification to higher cancer grade or volume on prostate biopsy. Primary outcomes were overall, cancer-specific, and metastasis-free survival. Secondary outcomes were the cumulative incidence of reclassification and curative intervention. Factors associated with grade reclassification and curative intervention were evaluated in a Cox proportional hazards model. A total of 1,298 men (median age, 66 years) with a median follow-up of 5 years (range, 0.01 to 18.00 years) contributed 6,766 person-years of follow-up since 1995. Overall, cancer-specific, and metastasis-free survival rates were 93%, 99.9%, and 99.4%, respectively, at 10 years and 69%, 99.9%, and 99.4%, respectively, at 15 years. The cumulative incidence of grade reclassification was 26% at 10 years and was 31% at 15 years; cumulative incidence of curative intervention was 50% at 10 years and was 57% at 15 years. The median treatment-free survival was 8.5 years (range, 0.01 to 18 years). Factors associated with grade reclassification were older age (hazard ratio [HR], 1.03 for each additional year; 95% CI, 1.01 to 1.06), prostate-specific antigen density (HR, 1.21 per 0.1 unit increase; 95% CI, 1.12 to 1.46), and greater number of positive biopsy cores (HR, 1.47 for each additional positive core; 95% CI, 1.26 to 1.69). Factors associated with intervention were prostate-specific antigen density (HR, 1.38 per 0.1 unit increase; 95% CI, 1.22 to 1.56) and a greater number of positive biopsy cores (HR, 1.35 for one additional positive core; 95% CI, 1.19 to 1.53). Men with favorable-risk prostate cancer should be informed of the low likelihood of harm from their diagnosis and should be encouraged to consider surveillance rather than curative intervention.